Congestive splenomegaly
Introduction
Introduction to congestive splenomegaly Congestive splenomegaly is an inflammation or thrombus of portal hypertension or portal vein or splenic vein caused by cirrhosis. Often accompanied by cirrhosis and portal hypertension, such as lower esophageal or gastric varices, ascites, dyspepsia, etc.; accompanied by hypersplenism, manifested as red blood cells, white blood cells and platelets are reduced by the "three less" phenomenon; Bone marrow hematopoietic function is strong. basic knowledge The proportion of illness: 0.004% Susceptible people: no specific people Mode of infection: non-infectious Complications: anemia
Cause
Congestive splenomegaly
Cause:
The most common cause of congestive splenomegaly is portal hypertension caused by cirrhosis; followed by inflammation or thrombosis of the portal vein or splenic vein.
Prevention
Congestive splenomegaly prevention
Pay attention to rest, work and rest, life in an orderly manner, and maintaining an optimistic, positive and upward attitude towards life can be of great help in preventing diseases.
Complication
Congestive splenomegaly complications Complications anemia
1. Spleen infarction.
2. Esophageal varices bleeding.
3. Blood cell reduction can cause infection.
4. Decreased platelet count can cause purpura or mucosal bleeding.
5. Anemia symptoms.
Symptom
Symptoms of congestive splenomegaly Common symptoms Dyspepsia Thrombocytopenia Ascites Leukopenia Yellow or brown splenomegaly portal hypertension
Congestive splenomegaly is often accompanied by cirrhosis and portal hypertension, such as lower esophageal or gastric varices, ascites, dyspepsia, etc.; accompanied by hypersplenism, manifested as red blood cells, white blood cells and platelets are reduced Less" phenomenon; at the same time, bone marrow hematopoietic function is strong.
Examine
Congestive splenomegaly
First, peripheral blood smear: Because many hematological lesions are related to congestive splenomegaly, special findings of peripheral blood examination can provide clues for the diagnosis of etiology (such as lymphocytosis in chronic leukemia, hereditary spherocytosis) Spherical erythrocytosis), platelets occasionally <50000 / l, accompanied by a decrease in mean platelet volume, in addition to leukemia, white blood cell count can be reduced, excessive basophils or nucleated red blood cells or teardrop red blood cells appear, suggesting myeloproliferation Diagnosis of sexual diseases.
Second, bone marrow examination: single line (or multi-lineage) cells can be seen but the corresponding peripheral blood cells are reduced; lymphatic infiltration can be seen in lymphoproliferative diseases; myeloid proliferative diseases, bone marrow cells proliferate; acute leukemia can be seen in the original Increased cells; fibrosis seen in myelofibrosis, myeloid metaplasia; Schiff staining of periodic acid is found in amyloidosis; macrophages with lipids are found in Gaucher's disease and related storage diseases.
3. Image examination: Colloidal spleen scanning with nuclide sputum is a reliable non-invasive examination method. The abdominal mass of the upper left quadrant can be determined by examination to determine the spleen, and the spleen size can be confirmed by CT scan. It can display a variety of abnormal features of endogenous and exogenous lesions. Magnetic resonance imaging can provide the same data as CT, and can also determine blood flow patterns, especially for portal vein and splenic vein thrombosis.
4. 51 Chromium-labeled erythrocyte and platelet life and spleen uptake function tests This special test is useful in determining the degree of retention of these cells when considering splenectomy.
V. Blood chemistry examination: Blood chemistry examination is helpful for the diagnosis of many diseases with splenomegaly. The presence of monoclonal gamma globulin disease or immunoglobulin reduction in serum electrophoresis suggests lymphoproliferative diseases or amyloidosis; Proteinemia can be seen in chronic infections (such as malaria, kala-azar, brucellosis, tuberculosis) or cirrhosis with congestive splenomegaly, sarcoma and collagen vascular disease; increased uric acid occurs in myeloproliferative diseases and lymphoid Proliferative diseases; leukocyte alkaline phosphatase is elevated in myeloproliferative diseases, but chronic myeloid leukemia is reduced; liver function tests can occur in a wide range of abnormalities in cirrhotic congestive splenomegaly, serum alkaline phosphatase alone Increased, as in the case of myeloproliferative diseases, lymphoproliferative diseases and miliary tuberculosis, suggesting liver infiltration, elevated serum vitamin B12 can be seen in myeloproliferative diseases, especially in chronic myelogenous leukemia and polycythemia vera, which is due to neutrality. The increase in vitamin B 12 binding protein released by polynuclear leukocytes.
Diagnosis
Diagnosis and diagnosis of congestive splenomegaly
Since anemia is caused by spleen retention, there is no special change in the morphology of red blood cells. When there are other blood cell reductions (platelet count is between 50,000 and 100,000/l; white blood cells are between 2,500 and 4000/l, the classification count is normal). This diagnosis can be prompted to determine the red blood cell life using the nuclide 51 chrome tracer, which can show accelerated destruction of red blood cells and selective spleen retention, and plasma volume determination is often significantly increased.
Differential diagnosis
(1) Spleen enlargement caused by infectious diseases: due to pathogen stimulation, macrophage and lymphocytes proliferate, resulting in congestion and swelling of the spleen.
(2) Spleen enlargement caused by abnormal immune reaction: patients with rheumatoid arthritis, systemic lupus erythematosus, idiopathic thrombocytopenic purpura, rheumatic fever, Behcet's disease, etc. may be caused by abnormal immune function of the body. Lymphocytes in the spleen, macrophages proliferate, and splenomegaly appears.
(3) Identification of abdominal masses.
